1
|
Koempel JA, Brooks J, Snow MH, Osterbauer B, Garcia E, Bawab R, Shows J, Parham D. The Relevance of and Surgical Approach to the Suprahyoid Region in Thyroglossal Duct Surgery. Laryngoscope 2020; 131:553-558. [PMID: 32668033 DOI: 10.1002/lary.28887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Persistent or recurrent disease following excision of a thyroglossal duct cyst/sinus (TGDC) is often found in the suprahyoid region. Cadaver dissections were performed to identify and name important surgical landmarks in the suprahyoid area; a histopathologic analysis of surgical specimens was completed to determine the incidence and extent of microscopic disease; and clinical outcomes were compared to determine the efficacy of a specific anatomic dissection. STUDY DESIGN Retrospective case series. METHODS Standardized dissections of four adult cadavers were performed. Consecutive surgical specimens were examined for evidence of microscopic TDGC disease in the suprahyoid region, measuring the greatest width and length of disease. A retrospective review of all consecutive TGDC procedures was completed. RESULTS The important surgical landmarks in the suprahyoid area were identified in all cadavers. Microscopic disease in the suprahyoid area was found in 79% (37 of 47) of surgical specimens. The mean greatest length and width of microscopic disease was 12.4 mm and 1.4 mm, respectively. Following identification of these landmarks, the incidence of recurrent or persistent disease decreased (P = .02) from 5% (8 of 159) to 0% (0 of 112). CONCLUSION The majority of pediatric patients with a TGDC will have microscopic disease in the suprahyoid area. The surgical landmark of the fascial plane between the geniohyoid and genioglossus muscles demarcates the anterior and lateral borders of resection in the suprahyoid area. This approach can be used as a reliable and easily reproducible technique in TGDC surgery to increase confidence of achieving complete removal of disease in the suprahyoid area, avoiding persistent or recurrent disease and a revision procedure. LEVEL OF EVIDENCE 4 Laryngoscope, 131:553-558, 2021.
Collapse
Affiliation(s)
- Jeffrey A Koempel
- Division of Otolaryngology - Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, California, U.S.A
| | - Jennifer Brooks
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Mikel H Snow
- Department of Cell and Neurobiology, Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A
| | - Beth Osterbauer
- Division of Otolaryngology - Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, California, U.S.A
| | - Erick Garcia
- Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A
| | - Ramzi Bawab
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California, U.S.A
| | - Jared Shows
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California, U.S.A
| | - David Parham
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California, U.S.A
| |
Collapse
|
2
|
Brucoli M, Boffano P, Benech A, Rosa S, Garzaro M, Aluffi Valletti P. Congenital nonvascular neck masses: a retrospective analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129:192-199. [DOI: 10.1016/j.oooo.2019.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 05/16/2019] [Accepted: 06/03/2019] [Indexed: 11/26/2022]
|
3
|
Brooks JA, Cunningham MJ, Koempel JA, Kawai K, Huang JK, Weitzman RE, Osterbauer B, Hughes AL. To drain or not to drain following a Sistrunk procedure: A dual institutional experience. Int J Pediatr Otorhinolaryngol 2019; 127:109645. [PMID: 31494373 DOI: 10.1016/j.ijporl.2019.109645] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/15/2019] [Accepted: 08/15/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION A Sistrunk procedure is the standard operative management of patients with thyroglossal duct cysts. Drain placement is commonly employed with the goal of reducing postoperative complications. This study investigates the association between drain use and relevant postoperative complications following pediatric Sistrunk procedures. METHODS Retrospective cohort study evaluating 295 pediatric patients treated between 2007 and 2016 at two tertiary care children's hospitals. RESULTS The mean age of the study population was 5.6 years (SD 4.0). A drain was utilized in 234 cases (79.3%). The mean procedural duration was 108 min (SD 48), and significantly longer in patients receiving a drain. Early postoperative complications included seroma (5.8%), secondary infection (3.4%), wound breakdown (2.0%) and hematoma (0.3%). The risk of such complications did not significantly differ between patients without drain placement (9.8%) versus those who underwent surgical drain placement (12.0%) after accounting for age and history of preoperative infection (adjusted RR = 0.86; 95% CI: 0.37, 1.98; p = 0.72). In the subgroup analysis, findings were consistent across institutions, age category, history of infection, and primary versus secondary procedure. CONCLUSION This dual institutional study found drain placement during a Sistrunk procedure may not reduce rates of common postoperative complications, even in longer duration cases in which a drain is more frequently placed. This data suggests a Sistrunk procedure may be safely performed without drain placement in select cases.
Collapse
Affiliation(s)
- Jennifer A Brooks
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Department of Otolaryngology, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
| | - Michael J Cunningham
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Department of Otolaryngology, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Jeffrey A Koempel
- Division of Otolaryngology, Children's Hospital Los Angeles, Department of Otolaryngology- Head & Neck Surgery University of Southern California, 4650 Sunset Avenue, Los Angeles, CA, 90027, USA
| | - Kosuke Kawai
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Department of Otolaryngology, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Jonathan K Huang
- Division of Otolaryngology, Children's Hospital Los Angeles, Department of Otolaryngology- Head & Neck Surgery University of Southern California, 4650 Sunset Avenue, Los Angeles, CA, 90027, USA
| | - Rachel E Weitzman
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Department of Otolaryngology, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Beth Osterbauer
- Division of Otolaryngology, Children's Hospital Los Angeles, Department of Otolaryngology- Head & Neck Surgery University of Southern California, 4650 Sunset Avenue, Los Angeles, CA, 90027, USA
| | - Amy L Hughes
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Department of Otolaryngology, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| |
Collapse
|
4
|
Isaacson G, Kaplon A, Tint D. Why Central Neck Dissection Works (and Fails) for Recurrent Thyroglossal Duct Remnants. Ann Otol Rhinol Laryngol 2019; 128:1041-1047. [PMID: 31271039 DOI: 10.1177/0003489419859033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To review the patient characteristics and outcomes for children and undergoing central neck dissection for control of recurrent thyroglossal duct cysts and fistula following prior Sistrunk procedures and children requiring surgery for refractory infection. METHODS We performed a computerized review of all children who were evaluated for thyroglossal duct cysts during the years 1999-2018 by a single surgeon operating at an urban children's hospital and an outpatient surgical center. Those requiring a central neck dissection for control of recurrent disease or intractable infection were identified. Age at time of surgery, sex, surgical procedure, and postoperative complications were recorded. These data were combined with similar data from a published report by the same surgeon in the years 1990-1998 to complete a 28-year review. RESULTS 18 central neck dissections were performed including 13 for recurrent thyroglossal duct remnants after Sistrunk procedures and 5 primary surgeries for intractable infection. Ages ranged from 3 to 19 years (median = 10 years) and 13 of 18 were girls (72%). Four children had their first Sistrunk surgery performed by the senior author. Three children operated elsewhere had intact hyoid bones at the time of revision surgery, suggesting less-than-Sistrunk primary surgeries. Central neck dissection controlled disease in the lower neck in all cases. One child re-fistulized at the level of the hyoid. CONCLUSIONS Central neck dissection in combination with a Sistrunk-type dissection of the tongue base is effective in the control of recurrent infection following unsuccessful Sistrunk surgery and aids in dissection for children with intractable infection. Although this technique reliably controls infrahyoid disease and improves access to the hyoid and posterior hyoid space, it does nothing to address the difficulties of following the thyroglossal tract into the tongue base.
Collapse
Affiliation(s)
- Glenn Isaacson
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.,Department of Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Adam Kaplon
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Derrick Tint
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.,Pittsburgh Ear Associates, PA, USA
| |
Collapse
|
5
|
The Central Neck Dissection or the Modified Sistrunk Procedure in the Treatment of the Thyroglossal Duct Cysts in Children: Our Experience. BIOMED RESEARCH INTERNATIONAL 2018. [PMID: 30018983 DOI: 10.1155/2018/8016957.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The aim of the study was to present the surgical techniques providing the lowest recurrence rate in treatment of the primary and recurrent thyroglossal duct cyst (TGDC) in children. Methods The study included 73 patients operated on because of TGDC in years 2011-2016. Ultrasound was performed in all patients preoperatively. In 8 patients with the recurrence of the disease, the CT or MR was carried out before the surgery. Children with the primary disease underwent the modified Sistrunk procedure. In the revision cases the central neck dissection was a method of choice. Results In 45 children, the modified Sistrunk procedure was performed and 28 underwent the central neck dissection. In 2 patients, hematoma occurred after the modified Sistrunk procedure with the need of the surgical revision in one. No complications were observed after the central neck dissection. Conclusions A modified Sistrunk procedure is method of choice in the treatment of the uncomplicated TGDC. In selected cases of the TGDC with a history of infected cyst or incision of an abscess or in revision cases the central neck dissection should be considered in order to avoid the risk of the further recurrences.
Collapse
|
6
|
The Central Neck Dissection or the Modified Sistrunk Procedure in the Treatment of the Thyroglossal Duct Cysts in Children: Our Experience. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8016957. [PMID: 30018983 PMCID: PMC6029493 DOI: 10.1155/2018/8016957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/16/2018] [Indexed: 11/17/2022]
Abstract
Background The aim of the study was to present the surgical techniques providing the lowest recurrence rate in treatment of the primary and recurrent thyroglossal duct cyst (TGDC) in children. Methods The study included 73 patients operated on because of TGDC in years 2011–2016. Ultrasound was performed in all patients preoperatively. In 8 patients with the recurrence of the disease, the CT or MR was carried out before the surgery. Children with the primary disease underwent the modified Sistrunk procedure. In the revision cases the central neck dissection was a method of choice. Results In 45 children, the modified Sistrunk procedure was performed and 28 underwent the central neck dissection. In 2 patients, hematoma occurred after the modified Sistrunk procedure with the need of the surgical revision in one. No complications were observed after the central neck dissection. Conclusions A modified Sistrunk procedure is method of choice in the treatment of the uncomplicated TGDC. In selected cases of the TGDC with a history of infected cyst or incision of an abscess or in revision cases the central neck dissection should be considered in order to avoid the risk of the further recurrences.
Collapse
|
7
|
Perkins JA, Inglis AF, Sie KCY, Manning SC. Recurrent Thyroglossal Duct Cysts: A 23-Year Experience and a New Method for Management. Ann Otol Rhinol Laryngol 2016; 115:850-6. [PMID: 17165669 DOI: 10.1177/000348940611501110] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: We present an experience in the management of primary and recurrent thyroglossal duct cysts (TGDCs) and describe a novel method for recurrent TGDC removal. Methods: We performed a retrospective review of TGDC surgery at Children's Hospital in Seattle from 1980 to 2003. The surgical techniques for primary and recurrent TGDCs and the factors associated with TGDC recurrence were evaluated and analyzed. Results: During the study period, 231 patients underwent 296 TGDC surgeries. Thirty-four of the 231 patients (15%) underwent a total of 88 procedures for recurrent TGDCs. Successful procedures used for secondary TGDC management included central neck dissection with directed base of tongue (BOT) excision in 6 of 9 patients (67%), secondary Sistrunk operation with limited BOT resection in 12 of 27 patients (44%), revision Sistrunk operation with BOT dissection in 7 of 11 patients (64%), and suture-guided transhyoid pharyngotomy in 8 of 8 patients (100%). Ten of the 231 patients (4%) had initial TGDC incision and drainage and then underwent a total of 21 procedures, excluding the incision and drainage. The factors associated with TGDC recurrence were inaccurate initial diagnosis (17 of 34 or 50%), infection (5 of 34 or 15%), unusual TGDC presentation (5 of 34 or 15%), and lack of BOT musculature removal (7 of 34 or 20%). The level of surgeon training affected the surgical outcome. Conclusions: Successful TGDC treatment requires consideration of factors associated with recurrence. Recurrent TGDCs can be treated by several methods, including suture-guided transhyoid pharyngotomy.
Collapse
Affiliation(s)
- Jonathan A Perkins
- Division of Pediatric Otolaryngology, Children's Hospital and Regional Medical Center, Seattle, WA 98105-0371 , USA
| | | | | | | |
Collapse
|
8
|
Righini CA, Hitter A, Reyt E, Atallah I. Thyroglossal duct surgery. Sistrunk procedure. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 133:133-6. [PMID: 26725753 DOI: 10.1016/j.anorl.2015.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Midline cysts of the neck are the most common congenital malformations of the neck. They arise along the thyroglossal duct. The presence of a fistula is the result of either spontaneous (suppuration) or surgical fistulisation (simple incision or incomplete excision). The cyst and/or fistula are located between the base of the tongue and the thyroid gland, predominantly adjacent to the hyoid bone. This midline site can be explained by embryological development of the thyroid gland. Treatment is surgical. Many techniques have been described, but Sistrunck procedure (described in 1920), based on embryological studies, remains the reference technique with a recurrence rate of less than 3%, provided surgery is performed correctly, comprising resection of the body of the hyoid. Risk factors for recurrence are: surgery during the inflammatory phase, cyst rupture during dissection, multiple thyroglossal ducts and a technical error during the surgical procedure.
Collapse
Affiliation(s)
- C-A Righini
- Pôle PALCROS, hôpital Nord-Michallon, clinique universitaire d'ORL, CS 10217, 38043 Grenoble cedex 09, France; Université de médecine Joseph-Fourier, Grenoble I, 38041 Grenoble cedex 9, France; Unité Inserm UJF/U823, centre de recherche Albert-Bonniot, site Santé, 38700 La Tronche, France.
| | - A Hitter
- Pôle PALCROS, hôpital Nord-Michallon, clinique universitaire d'ORL, CS 10217, 38043 Grenoble cedex 09, France
| | - E Reyt
- Pôle PALCROS, hôpital Nord-Michallon, clinique universitaire d'ORL, CS 10217, 38043 Grenoble cedex 09, France; Université de médecine Joseph-Fourier, Grenoble I, 38041 Grenoble cedex 9, France
| | - I Atallah
- Pôle PALCROS, hôpital Nord-Michallon, clinique universitaire d'ORL, CS 10217, 38043 Grenoble cedex 09, France; Université de médecine Joseph-Fourier, Grenoble I, 38041 Grenoble cedex 9, France; Unité Inserm UJF/U823, centre de recherche Albert-Bonniot, site Santé, 38700 La Tronche, France
| |
Collapse
|
9
|
A 16-year experience in treating thyroglossal duct cysts with a “conservative” Sistrunk approach. Eur Arch Otorhinolaryngol 2015; 273:1019-25. [DOI: 10.1007/s00405-015-3571-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 02/18/2015] [Indexed: 10/23/2022]
|
10
|
Rohof D, Honings J, Theunisse HJ, Schutte HW, van den Hoogen FJA, van den Broek GB, Takes RP, Wijnen MHWA, Marres HAM. Recurrences after thyroglossal duct cyst surgery: Results in 207 consecutive cases and review of the literature. Head Neck 2014; 37:1699-704. [PMID: 24985922 DOI: 10.1002/hed.23817] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 04/04/2014] [Accepted: 06/26/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND A thyroglossal duct cyst is the most common form of congenital anomaly in the neck. Surgical removal is very effective. However, in some cases, a cyst recurs. The purpose of this study was to identify factors that predispose to recurrence of a thyroglossal duct cyst. METHODS A retrospective study was conducted of consecutive patients who underwent surgical resection for histologically confirmed thyroglossal duct cysts between 1998 and 2013 in a tertiary referral center. RESULTS Two hundred seven patients were included. The overall recurrence rate was 9.7%. The most important factor predicting recurrence was the type of resection: recurrence rate was 5.3% after the Sistrunk procedure, and 55.6% after plain excision (p < .001). The only other factor that was significantly associated with chance of recurrence was postoperative infection. CONCLUSION The Sistrunk procedure is the treatment of choice for thyroglossal duct cysts because it yields low recurrence and morbidity. Postoperative infections, rather than preoperative infections, are associated with recurrence.
Collapse
Affiliation(s)
- Daan Rohof
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jimmie Honings
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henricus J Theunisse
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henrieke W Schutte
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank J A van den Hoogen
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Guido B van den Broek
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert P Takes
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marc H W A Wijnen
- Department of Pediatric Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henri A M Marres
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
11
|
Pastore V, Bartoli F. "Extended" Sistrunk procedure in the treatment of recurrent thyroglossal duct cysts: a 10-year experience. Int J Pediatr Otorhinolaryngol 2014; 78:1534-6. [PMID: 25048858 DOI: 10.1016/j.ijporl.2014.06.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/25/2014] [Accepted: 06/28/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We report a 10-year experience of children with recurrent thyroglossal duct cysts (TGDCs) who have been treated using the "extended" Sistrunk procedure. METHODS We performed a retrospective review of TGDC surgery from 2004 to 2013. Sistrunk operation was the procedure of choice in all patients. Seven children had TGDC recurrence. All of them underwent "extended" Sistrunk procedure. Follow up ranged from 6 months to 8 years. RESULTS There were no gender differences, all recurrences presented within 12 months follow-up in the same location of the primary cyst. Five out of 7 (71%) patients have been treated for preoperative and 2/7 (29%) for postoperative infection at the time of primary surgery. Pathological examination of the surgical specimens showed a single tract in 2 children (29%) and multiple tracts in 5 (71%). We did not observe postoperative complications or further recurrences. CONCLUSION Our experience suggest that recurrent TGDCs are equally common in both sexes, develop in the same location of the primary cyst and recur more commonly after perioperative infections. The "extended" Sistrunk procedure is highly effective and safe in treating recurrent TGDCs also if multiple duct tracts are detected.
Collapse
Affiliation(s)
- Valentina Pastore
- Pediatric Surgery Unit, Medical and Surgical Sciences Department, University of Foggia, Italy.
| | - Fabio Bartoli
- Pediatric Surgery Unit, Medical and Surgical Sciences Department, University of Foggia, Italy
| |
Collapse
|
12
|
de Tristan J, Zenk J, Künzel J, Psychogios G, Iro H. Thyroglossal duct cysts: 20 years' experience (1992-2011). Eur Arch Otorhinolaryngol 2014; 272:2513-9. [PMID: 25135577 DOI: 10.1007/s00405-014-3229-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 07/31/2014] [Indexed: 10/24/2022]
Abstract
The objective of the present study is to report on the clinical course and management of thyroglossal duct cysts. Retrospective review of all patients who underwent surgery for thyroglossal duct cysts between 2000 and 2013 at a tertiary referral center was carried out. The operations were performed using a modification of the Sistrunk operation: transcervical cystectomy, partial dissection of the hyoid bone, and dissection of all tracts identified during surgery. A total of 352 patients (176 men, 176 women) underwent surgery for a cyst (n = 282) or discharging sinus (n = 70). The mean age for the incidence of cysts was 26 years. Four of the patients (1.4 %) had a papillary thyroid carcinoma in the epithelium of the cyst. The follow-up period ranged from 7 months to 10 years. The overall recurrence rate was 4.5 %. Resection is often regarded as an elective surgical procedure in patients with thyroglossal duct cysts, but surgery should always be considered. Papillary thyroid carcinoma in the epithelium of the cyst is a rare but possible differential diagnosis. Dissection of all tracts found is recommended and partial dissection of the hyoid bone is mandatory. Dissection of the foramen cecum is not imperative. The recurrence rates with this approach are comparable to more extensive methods such as those described by Sistrunk.
Collapse
Affiliation(s)
- Julie de Tristan
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg Medical School, Waldstrasse 1, 91054, Erlangen, Germany,
| | | | | | | | | |
Collapse
|
13
|
Ren W, Zhi K, Zhao L, Gao L. Presentations and management of thyroglossal duct cyst in children versus adults: a review of 106 cases. ACTA ACUST UNITED AC 2011; 111:e1-6. [PMID: 21237423 DOI: 10.1016/j.tripleo.2010.10.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Revised: 10/08/2010] [Accepted: 10/28/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to determine the clinical presentations and management of thyroglossal duct cyst (TDC or thyroglossal tract remnant [TTR]) between children and adults and evaluate risk factors associated with recurrence after surgery for TDCs. STUDY DESIGN A retrospective study of all patients with TDCs managed in our department from January 1998 through April 2008 was performed. All records were reviewed for age and sex, sizes and locations of cysts, diagnostic methods, surgical management, recurrences, and complications. Differences between children and adults and risk factors associated with recurrence were evaluated. RESULTS A total of 106 patients (47 children and 59 adults) were treated for TDC. Of the children, 57.4% were male and 42.6% were female, whereas 50.8% of the adults were male and 49.2% were female. There were no significant differences in sex in either group (P > .49). The average age was 7.0 ± 4.2 years in children and 36.0 ± 18.0 years in adults, which demonstrates a bimodal distribution. Adults were significantly more likely than children to present with a complaint other than mass or infection (P < .01), including pain, dysphagia, dysphonia, and fistula formation. There was no significant difference in frequency of location between the adults and children. In this article, 94.9% (56/59) of the adults and 87.2% (41/47) of the children underwent a Sistrunk operation, whereas the others underwent cyst excision. There were 2 recurrences among adults and 3 among children, all of whom presented with an infected neck mass and were treated with a second Sistrunk procedure. The recurrence rates and complications between children and adults were not significantly different. CONCLUSIONS The incidence of TDC was equal in males and females and had a bimodal distribution with similar incidence in children and adults. Adults were significantly more likely than children to present with a complaint other than mass or infection. The Sistrunk procedure is recommended as the main choice of treatment. Cyst infection may have a role in recurrence.
Collapse
Affiliation(s)
- Wenhao Ren
- Department of Oral and Maxillofacial Surgery/Oncological Head and Neck Surgery, Stomatological Hospital, College of Medicine, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | | | | | | |
Collapse
|
14
|
Munson PD, Thompson DM, Orvidas LJ. Obstructive lingual tonsil hypertrophy in recurrent thyroglossal duct cyst. Int J Pediatr Otorhinolaryngol 2007; 71:1837-41. [PMID: 17905446 DOI: 10.1016/j.ijporl.2007.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Revised: 08/09/2007] [Accepted: 08/09/2007] [Indexed: 11/15/2022]
Abstract
The association between recurrent thyroglossal duct cyst (TGDC) and obstructive lingual tonsil hypertrophy has not previously been discussed. We present the case of a 7-year-old child whose medical and surgical course was complicated by these synchronous factors. The aim of this report is to present the risk factors for recurrence of TGDC and the unique challenge that concurrent lingual tonsil hypertrophy and airway obstruction present to management of patients.
Collapse
Affiliation(s)
- Patrick D Munson
- Department of Otorhinolaryngology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | | | | |
Collapse
|
15
|
Mondin V, Ferlito A, Muzzi E, Silver CE, Fagan JJ, Devaney KO, Rinaldo A. Thyroglossal duct cyst: personal experience and literature review. Auris Nasus Larynx 2007; 35:11-25. [PMID: 17720342 DOI: 10.1016/j.anl.2007.06.001] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Accepted: 06/19/2007] [Indexed: 10/22/2022]
Abstract
The thyroglossal duct cyst [TDC, or thyroglossal tract remnant (TTR)] is a well recognized developmental abnormality which arises in some 7% of the population. As a consequence, it represents the most common type of developmental cyst encountered in the neck region. It typically presents as a mobile, painless mass in the anterior midline of the neck, usually in close proximity to the hyoid bone. Less often, TDCs may present with signs and symptoms of secondary infection, or with evidence of a fistula. While TDCs are most often diagnosed in the pediatric age group, a substantial minority of patients with TDCs are over 20 years of age at the time of diagnosis. The standard surgical approach to TDC, encompassing removal of the mid-portion of the hyoid bone in continuity with the TDC and excision of a core of tissue between the hyoid bone and the foramen cecum, dates back to the late 19th and early 20th centuries and is often referred to as Sistrunk's operation. Malignancy is rarely encountered in TDCs; when such rare tumors do develop (in the order of 1% or so of patients with TDCs), they usually take the form of either papillary carcinoma of thyroid origin, or squamous carcinoma.
Collapse
Affiliation(s)
- Vanni Mondin
- Department of Surgical Sciences, ENT Clinic, University of Udine, Udine, Italy
| | | | | | | | | | | | | |
Collapse
|
16
|
|
17
|
Brousseau VJ, Solares CA, Xu M, Krakovitz P, Koltai PJ. Thyroglossal duct cysts: presentation and management in children versus adults. Int J Pediatr Otorhinolaryngol 2003; 67:1285-90. [PMID: 14643470 DOI: 10.1016/j.ijporl.2003.07.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To determine if the clinical presentation of thyroglossal duct cysts (TGDC) varies between children and adults and whether this knowledge helps optimize the surgical management. METHODS We retrospectively identified all patients with TGDC managed in our department between 1992 and 2002. We reviewed the patients' charts and recorded their gender, age at diagnosis, clinical presentation, radiologic imaging, surgical management, post-operative complications, and recurrence rate and compared the variables between the children and adults. RESULTS Twenty-one children and 41 adults were treated for TGDC. Of the children, 57% were male and 43% were female, whereas 49% of the adults were male and 51% were female (P = 0.53). The average age was 6 +/- 5 years in children and 45 +/- 16 years in adults, which demonstrates a bimodal distribution. Forty-three percent of children and 42% of adults presented with an infected neck mass (P > 0.99). Among our patients, 96% of the adults and 100% of the children underwent a Sistrunk operation. Four children developed a wound infection that resolved with antibiotics. One adult developed a haematoma and another developed a wound seroma. There was one recurrence among adults and one among children, both of whom were treated with a second Sistrunk procedure. CONCLUSIONS There appears to be a bimodal distribution for age at presentation of TGDC. Since the differential diagnosis among adults is broader, the opportunity for misdiagnosis is greater. However, once the correct diagnosis is made, the surgical management and post-operative outcome between adults and children is the same.
Collapse
|